Medial Opening Wedge High Tibial Osteotomy: Diagnostic Evaluation and Surgical Technique Overview
-
Omid Salkhori
,
Mohammad Ayati Firoozabadi
,
Hesan Rezaee
,
Hamed Naghizadeh
,
Seyed Mohammad Javad Mortazavi
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a knee-preserving surgical option for selected patients with symptomatic medial compartment osteoarthritis (OA) and varus malalignment. Successful outcomes depend on appropriate patient selection, accurate radiographic assessment, individualized correction planning, stable fixation, and careful intraoperative protection of the lateral hinge and posterior neurovascular structures. This educational review summarizes the practical steps in the evaluation and surgical planning of MOWHTO, including clinical assessment, classification of varus deformity, imaging, indications and contraindications, correction target, osteotomy orientation, hinge position, fixation options, bone grafting, drain use, and postoperative considerations. The review also compares MOWHTO with lateral closing wedge high tibial osteotomy (LCWHTO) and discusses areas where evidence remains inconclusive. Rather than proposing a single universal technique, this article emphasizes individualized decision-making based on patient anatomy, severity of OA, ligament status, patellofemoral joint condition, planned correction, and surgeon experience.
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2. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-54. [PubMed: 3818700].
3. Ji W, Luo C, Zhan S, Zhan Y, Xie X, Zhang B. Combined proximal tibial osteotomy for varus osteoarthritis of the knee: Biomechanical tests and finite-element analyses. Knee. 2020;27(3):863-70. doi: 10.1016/j.knee.2020.01.006. [PubMed: 32046900].
4. Kikuchi K, Kumagai K, Yamada S, Nejima S, Choe H, Ike H, et al. Difference in the anterior displacement of the tibial tuberosity relative to the proximal tibial fragment between opening wedge and closed wedge high tibial osteotomies. Sicot j. 2024;10:21. doi: 10.1051/sicotj/2024020. [PubMed: 38819291]. [PubMed Central: PMC11141518].
5. Mestriner AB, Ackermann J, Merkely G, Ogura T, Zicaro JP, Gomoll AH. Biplanar ascending opening-wedge high tibial osteotomy increases tibial tubercle–trochlear groove distance and decreases patellar height. J ISAKOS. 2020;5(1):15-20. doi: 10.1136/jisakos-2019-000389.
6. Li OL, Pritchett S, Giffin JR, Spouge ARI. High Tibial Osteotomy: An Update for Radiologists. AJR Am J Roentgenol.2022;218(4):701-12. doi: 10.2214/ajr.21.26659. [PubMed: 34817194].
7. Ruzbarsky JJ, Dare DM, Marx RG. Closing Verses Opening Wedge High Tibial Osteotomy: an Evidence-Based Review. Hss J. 2015;11(3):291-3. doi: 10.1007/s11420-015-9440-1. [PubMed:
26981064]. [PubMed Central: PMC4773684].
8. Mattei L, Lea S, Nicolaci G, Ferrero G, Marmotti A, Castoldi F. Closing wedge tibial osteotomy: is it an actual procedure nowadays? Ann Joint. 2017;2:30. doi: 10.21037/aoj.2017.06.04.
9. Sun H, Zhou L, Li F, Duan J. Comparison between Closing- Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Knee Surg. 2017;30(2):158-65. doi: 10.1055/s-0036-1584189. [PubMed: 27218480].
10. Capella M, Gennari E, Dolfin M, Saccia F. Indications and results of high tibial osteotomy. Ann Joint. 2017;2:33. doi: 10.21037/aoj.2017.06.06.
11. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res. 1992(274): 248-64. [PubMed: 1729010].
12. Noyes FR, Mayfield W, Barber-Westin SD, Albright JC, Heckmann TP. Opening wedge high tibial osteotomy: an operative technique and rehabilitation program to decrease complications and promote early union and function. Am J Sports Med. 2006;34(8):1262-73. doi: 10.1177/0363546505286144. [PubMed: 16493168].
13. Brown GA, Amendola A. Radiographic evaluation andpreoperative planning for high tibial osteotomies. Oper Tech Sports Med. 2000;8(1):2-14. doi: 10.1016/S1060- 1872(00)80018-0.
14. Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012;24(2):61-9. doi: 10.5792/ksrr.2012.24.2.61. [PubMed: 22708105]. [PubMed Central: PMC3374001].
15. Palmer J, Getgood A, Lobenhoffer P, Nakamura R, Monk P. Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: A state-of-the-art review. J isakos. 2024;9(1):39-52. doi: 10.1016/j.jisako.2023.10.004. [PubMed: 37839705].
16. McCormack DJ, Puttock D, Godsiff SP. Medial compartment osteoarthritis of the knee: a review of surgical options. EFORT Open Rev. 2021;6(2):113-7. doi: 10.1302/2058-5241.6.200102. [PubMed: 33828854]. [PubMed Central: PMC8022014].
17. Chahla J, Dean CS, Mitchell JJ, Moatshe G, Serra Cruz R, LaPrade RF. Medial Opening Wedge Proximal Tibial Osteotomy. Arthrosc Tech. 2016;5(4):e919-e28. doi: 10.1016/j.eats.2016.04.019. [PubMed: 27709059]. [PubMed Central: PMC5040605].
18. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-6. doi: 10.1097/01.blo.0000229362.12244.f6. [PubMed: 16906111].
19. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999(367):18-27. [PubMed: 10546594].
20. Gstöttner M, Pedross F, Liebensteiner M, Bach C. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg. 2008;128(1):111-5. doi: 10.1007/s00402-007-0438-0. [PubMed: 17828411].
21. Stuchin SA, Johanson NA, Lachiewicz PF, Mont MA. Surgical management of inflammatory arthritis of the adult hip and knee. Instr Course Lect. 1999;48:93-109. [PubMed: 10098032].
22. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High Tibial Osteotomy: A Systematic Review and Current Concept. Arch Bone Jt Surg. 2016;4(3):204-12. [PubMed: 27517063]. [PubMed Central: PMC4969364].
23. Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop. 2010;34(2):155-60. doi: 10.1007/s00264-009-0889-8. [PubMed: 19838706]. [PubMed Central: PMC2899364].
24. Agarwala S, Sobti A, Naik S, Chaudhari S. Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up. J Clin Orthop Trauma. 2016;7(4):272-5. doi: 10.1016/j.jcot.2016.06.012. [PubMed: 27857502]. [PubMed Central: PMC5106481].
25. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, et al. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am. 2014;96(17):1425-32. doi: 10.2106/jbjs.M.00786. [PubMed: 25187580].
26. Safdari M, Dastjerdi A, Makhmalbaf N, Makhmalbaf M, Makhmalbaf H. Closing-Wedge and Opening-Wedge High Tibial Osteotomy as Successful Treatments of Symptomatic Medial Osteoarthritis of the Knee: A Randomized Controlled Trial. Arch Bone Jt Surg. 2023;11(6):421-8. doi: 10.22038/abjs.2023.68944.3253. [PubMed: 37404296]. [PubMed Central: PMC10314979].
27. Liu X, Chen Z, Gao Y, Zhang J, Jin Z. High Tibial Osteotomy: Review of Techniques and Biomechanics. J Healthc Eng. 2019;2019:8363128. doi: 10.1155/2019/8363128. [PubMed: 31191853]. [PubMed Central: PMC6525872].
28. Magyar G, Ahl TL, Vibe P, Toksvig-Larsen S, Lindstrand A. Open- wedge osteotomy by hemicallotasis or the closed-wedge technique for osteoarthritis of the knee. A randomised study of 50 operations. J Bone Joint Surg Br. 1999;81(3):444-8. doi: 10.1302/0301-620x.81b3.8925. [PubMed: 10872363].
29. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11(3):132-8. doi: 10.1007/s00167-002- 0334-7. [PubMed: 12774149].
30. Brouwer RW, Bierma-Zeinstra SM, van Koeveringe AJ, Verhaar JA. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br. 2005;87(9):1227-32. doi: 10.1302/0301-620x.87b9.15972. [PubMed: 16129748].
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| Files | ||
| Issue | Vol 12 No 4 (2026) | |
| Section | Review Article | |
| Keywords | ||
| Osteotomy Knee Tibial Fractures | ||
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How to Cite
1.
Salkhori O, Ayati Firoozabadi M, Rezaee H, Naghizadeh H, Mortazavi SMJ. Medial Opening Wedge High Tibial Osteotomy: Diagnostic Evaluation and Surgical Technique Overview. J Orthop Spine Trauma. 2026;12(4):167-73.
